ALABAMA DEPARTMENT OF REVENUE
MOTOR VEHICLE DIVISION
Application For Replacement Credentials
MV 40-12-265-1
6/20
LAST, FIRST, MIDDLE OR ORGANIZATION NAME TELEPHONE NUMBER EMAIL
PHYSICAL ADDRESS COUNTY MAILING ADDRESS ( IF DIFFERENT FROM PHYSICAL ADDRESS)
CITY STATE ZIP
PLATE NUMBER VEHICLE IDENTIFICATION NUMBER OFFICE USE ONLY
6
License Plate
6
Decal
6
Registration Receipt (current registration period only)
6
Stolen/Lost - It is the responsibility of the registrant to notify the appropriate law enforcement agency regarding lost or stolen
license plates.
6
Mutilated/Damaged - License plate must be surrendered to the appropriate license plate issuing official. If the license plate
cannot be surrendered, a statement as
to the certification of the destruction of the license plate may be submitted.
6
Incorrect - A copy of the original registration receipt reflecting the incorrect information should be submitted with this form, if
available. Do not return the original registration receipt.
6
Never Received - License plate or decal that was issued but never received due to being lost in the mail.
VEHICLE INFORMATION
REGISTRANT INFORMATION
REPLACEMENT CREDENTIALS REQUESTED Replacement fee is determined by local licensing office.
REASON FOR REPLACEMENT
I certify, under penalty of perjury that the above information provided is true and correct
Signature: ___________________________________________________________________________ Date: _________________
For credentials issued by the ADOR MVD only (state, county, municipal, PUD, US government loaned, consular official, volun-
teer fire department, or IRP) submit this application to the ADOR MVD.
This form is used to request a replacement license plate, replacement validation decal or a current registration receipt issued by the
licensing official. Return this application with payment to your local licensing official's office
.
Should the lost license plate be recovered or come into the possession of the applicant, the license plate must immediately be deliv-
ered to the local licensing authority. Should any person use upon any motor vehicle the old tag or validation stamp, they may be
arrested and upon conviction shall be guilty of a misdemeanor in accordance with Section 40-12-265, Code of Ala. 1975
.
CITY STATE ZIP
